Stigma Prevents Better Pain Management and Addiction Treatment
A team, based in primary care
Typically, Watkins said, people needing treatment for OUD or a mental health condition seek help from their primary care provider rather than an addiction or mental health specialist. But many primary care providers lack expertise in mental health treatment.
Collaborative Care works within this primary care setting. People seeking treatment do not need to get an appointment with a specialist in mental health conditions or addiction. Rather, a care manager within the primary care setting helps schedule and organize the patient’s treatment from many providers, including specialists. In this way, Collaborative Care expands the network of providers able to help treat OUD and mental health conditions. It can also make care more economical and easier for people to access, particularly in rural areas.
“Depression impacts your ability to get up and go—the hopefulness, the sense that things can change,” said Watkins, which makes it more important to eliminate obstacles in the way to treatment.
In the study, the care manager works with a behavioral health consultant, a psychiatrist who makes recommendations about treatment and regularly reviews the patient’s progress. The primary care provider works directly with the patient on treatment. A behavioral health provider, most likely a social worker or a psychologist, delivers psychotherapy to the patient. The care manager also checks in periodically to assess the patient’s progress, another component of the Collaborative Care Model. If the patient is not improving, the care manager will work with the rest of the team to adjust the treatment plan.
The structure of Collaborative Care teams can vary. In the New Mexico study, a community health worker will serve as the care manager, who works with each patient, keeping track of their needs and helping them problem-solve when they experience barriers, Watkins said.
“They’re being proactive, saying, ‘Mr. Smith, you have an appointment tomorrow—do you need a bus token?” Watkins explained. “Or ‘I see you only have five days of medication left, but you don’t have a follow-up appointment.’”
The care managers also employ a motivational interviewing technique, in which they ask the patient questions about what might make them consider treatment for depression or OUD. If the person wishes to start treatment, the care manager can set up an appointment. If the person decides not to start treatment right away, or only to start treatment for one condition, the care manager will let it go without judgment—knowing they have planted a seed in the person’s mind that might enable them to change their mind and seek help later.
The study team plans to enroll 1,000 participants who will be randomly assigned to either Collaborative Care or their usual healthcare. Researchers will follow up with all participants by phone after three months and six months. They will be looking at whether participants start medication treatment for OUD, whether they stay on that medication continuously, and whether their PTSD or depression symptoms are getting better.
Helping patients when they need it most
In her previous work at a residential treatment center, Watkins saw up close how difficult the lives of people with co-occurring mental health conditions and OUD could be. She also saw how help could come earlier if their primary care provider had been able to connect them with appropriate care.
“You see how much many of them struggled and really tried, and we, as a healthcare system, weren’t there,” Watkins said. “When they were ready, we were not there to help. We need to be there when they’re ready.”
Find More Projects in This Research Focus Area
Explore programs and funded projects within the New Strategies to Prevent and Treat Opioid Addiction research focus area.
National Institute of Mental Health (NIMH)
Learn more about NIMH's role in the NIH HEAL Initiative.
National Institute of Neurological Disorders and Stroke (NINDS)
Learn more about NINDS’ role in the NIH HEAL Initiative.